The Closing of Haverford State
Joanne Silberner
The Infinite Mind
THE CLOSING OF HAVERFORD STATE: A SPECIAL REPORT
This special report is the result of reporter Joanne Silberner's year-long investigation. She took time off from her regular job as a National Public Radio health correspondent to bring listeners "The Closing of Haverford State." This special report has won three major journalism awards since it was first broadcast in 1999, including a Clarion Award, an EDI Award from National Easter Seals and a Deadline Award from Sigma Delta Chi, the Society of Professional Journalists.
Until the 1800s most mentally ill people were kept hidden away, usually in private homes, and often neglected or abandoned. Then reformer Dorothea Dix brought about change by lobbying to get the government involved. Psychiatric hospitals sprang up all over the country. They were meant to provide a safe haven for the mentally ill.
In reality, many hospitals were unable to offer much in the way of treatment or cure. But until the 1950s they were an important part of the American landscape. Then things began to change. New medications effective in treating the symptoms of mental illness meant that some could leave the institutions. As abusive conditions in many hospitals became more widely known, states began to think twice about building more. Higher health-care costs were also an important factor, and mental health advocates began to lobby against forced hospitalization, which became more difficult legally. As a result, the number of people in such facilities nation-wide began to plummet through the 60s, 70s, and 80s. According to the Center for Mental Health Services of the U.S. Public Health Service, in 1962, there were 526,000 people in state and county mental hospitals -- in 1996, just 70,000 remained.
Haverford State Hospital was located in suburban Philadelphia. In 1997, Pennsylvania announced that the hospital would close its doors in June of 1998.
Aidan Altenor was the superintendent of the hospital. He explains how he is actually in favor of its closing, due to innovations in community-based care and medications.
We learn about the history of the hospital from staff members. When it was built in 1964 it was known as the "Haverford Hilton," boasting bowling alleys and private rooms. But conditions declined in the 1970s. Overcrowding meant patients might sleep in hallways or dayrooms. Many were kept in seclusion and restraints, heavily drugged, or subjected to shock treatments as a form of discipline. One nurse explains that the philosophy was that patients did not have choices about much of anything, including whether or not to take a bath.
By the 1990s Haverford State had transformed itself. Patients were involved in education and recreational activities and enjoyed the beautiful grounds. The treatment philosophy emphasized self-help, and patients worked at jobs inside the hospital. Some were allowed to leave the grounds at regular intervals.
Ms. Silberner spent over a year with three patients: Carlos Prigg, Kathy Schreffler, and "Sarah," who asked that her real name not be used in this program.
Carlos has paranoid schizophrenia. He was admitted to the hospital in 1979 when he was charged with assault and judged incompetent to stand trial. When Joanne first meets him, he is quite happy at the hospital, working in the canteen, and does not look forward to leaving. He is a generous man who shares the $40 he receives each week from the government with fellow patients.
Kathy, like 17 million other Americans, suffers from depression. She came to Haverford because of a suicide attempt following the death of several close relatives. She is ambivalent about leaving the hospital, looking forward to it one day, apprehensive the next.
Sarah used to ride the horse show circuit. Her manic depression has led her to cycle in and out of hospitals. She still loves horses and would like to leave Haverford, but lacks confidence in herself. She and her sister recount how her manic episodes have caused problems in the past.
Joanne interviews Charles Curie of the Pennsylvania State Department of Public Welfare. He explains how alternatives to institutional care are less expensive and less likely to encourage dependency. People do better in community care, he says.
In fact, when a hospital in Philadelphia closed, it was tracked by economists from the University of Pennsylvania. They found public money to be better spent on community care--and no increase in homelessness from the closure.
Haverford's closing was in part spurred by a lawsuit that used the Americans With Disabilities Act to argue people with mental illnesses should be kept in the least restrictive setting possible. The courts agreed and set up a strict timetable for transition to community-based care.
Robbie Altenor is the wife of Aidan Altenor and an advocate for community-based care. Her job, she says, is not always easy. Zoning regulations and people's attitudes and fears can make setting-up smaller facilities difficult.
Where are Carlos, Sarah, and Kathy now, nine months after Haverford State shut its doors?
Sarah lives in her own apartment and works two part-time jobs. One is in a department store, where she was recently given a sales award. The other is at a barn where she can work with her beloved horses.
By most accounts, her life looks good. But there are problems. On her own Sarah cannot afford her medications, which run to as much as $400 a month, and regular visits to both psychiatrist and psychologist. So she gets heath insurance through public assistance (SSDI), but the aid means she cannot work as many hours as she would like. At the same time, she has become friends with her landlord but keeps her distance from most others. She is afraid people who know her will be turned off by the fact that she was in the hospital. Sometimes she misses the way things were "taken care of" at Haverford.
The staff at Haverford decided Carlos was not ready to be discharged. He moved on to Norristown State Hospital, another psychiatric facility. But after 20 years at Haverford, the transition has been difficult. Carlos was in good spirits when Joanne spoke to him last, but he has been involved in fights with other patients and even threw a chair at the nurses' station. Still, Aidan Altenor, who now runs Norristown State, is confident that one day Carlos will be well enough to live outside an institution. In fact, he blames Carlos' current difficulties in part on his two decades in institutions.
Kathy lives in a group home in Boothwyn, PA run by an organization called Impact. She likes it there very much--more than Haverford--and is currently in a work program, learning to use computers. Sometimes she misses the people from Haverford, but she likes the freer atmosphere of her new home.
Joe Rogers, Executive Director of the Mental Health Association of Southeastern Pennsylvania and Joe Bevilacqua, a mental health policy expert who's been commissioner of mental health in three states, comment on the need for community treatment as opposed to hospitalization in large state facilities.
Patient advocate Jo Halberstadter says she is excited by the trend toward community care. Giving people a higher degree of responsibility and independence, she says, pays off. They become more responsible and independent themselves.
Joanne Silberner ends the piece by observing that people with mental illnesses are now being returned to their communities--where they were before Dorothea Dix started her reforms. The difference is that now the government is involved. It's the follow-through to de-institutionalization is the most crucial part. Will other state governments commit to community care--with government supervision--the way that Pennsylvania has? What might happen if they don't? These questions remain to be answered.
For more information about mental illnesses, their treatment, and community support programs, you can contact any of the following groups:
National Mental Health Association
phone: 800-969-6642
National Alliance for the Mentally Ill
phone: 800-950-6264
Depression and Bipolar Support Alliance
phone: 800-826-3632
For more information on the closing of Haverford State Hospital you can contact the Mental Health Association of Southeastern Pennsylvania at 800-688-4226.
This program was funded by a grant from the Kaiser Media Fellowship Program.
This special report is the result of reporter Joanne Silberner's year-long investigation. She took time off from her regular job as a National Public Radio health correspondent to bring listeners "The Closing of Haverford State." This special report has won three major journalism awards since it was first broadcast in 1999, including a Clarion Award, an EDI Award from National Easter Seals and a Deadline Award from Sigma Delta Chi, the Society of Professional Journalists.
Until the 1800s most mentally ill people were kept hidden away, usually in private homes, and often neglected or abandoned. Then reformer Dorothea Dix brought about change by lobbying to get the government involved. Psychiatric hospitals sprang up all over the country. They were meant to provide a safe haven for the mentally ill.
In reality, many hospitals were unable to offer much in the way of treatment or cure. But until the 1950s they were an important part of the American landscape. Then things began to change. New medications effective in treating the symptoms of mental illness meant that some could leave the institutions. As abusive conditions in many hospitals became more widely known, states began to think twice about building more. Higher health-care costs were also an important factor, and mental health advocates began to lobby against forced hospitalization, which became more difficult legally. As a result, the number of people in such facilities nation-wide began to plummet through the 60s, 70s, and 80s. According to the Center for Mental Health Services of the U.S. Public Health Service, in 1962, there were 526,000 people in state and county mental hospitals -- in 1996, just 70,000 remained.
Haverford State Hospital was located in suburban Philadelphia. In 1997, Pennsylvania announced that the hospital would close its doors in June of 1998.
Aidan Altenor was the superintendent of the hospital. He explains how he is actually in favor of its closing, due to innovations in community-based care and medications.
We learn about the history of the hospital from staff members. When it was built in 1964 it was known as the "Haverford Hilton," boasting bowling alleys and private rooms. But conditions declined in the 1970s. Overcrowding meant patients might sleep in hallways or dayrooms. Many were kept in seclusion and restraints, heavily drugged, or subjected to shock treatments as a form of discipline. One nurse explains that the philosophy was that patients did not have choices about much of anything, including whether or not to take a bath.
By the 1990s Haverford State had transformed itself. Patients were involved in education and recreational activities and enjoyed the beautiful grounds. The treatment philosophy emphasized self-help, and patients worked at jobs inside the hospital. Some were allowed to leave the grounds at regular intervals.
Ms. Silberner spent over a year with three patients: Carlos Prigg, Kathy Schreffler, and "Sarah," who asked that her real name not be used in this program.
Carlos has paranoid schizophrenia. He was admitted to the hospital in 1979 when he was charged with assault and judged incompetent to stand trial. When Joanne first meets him, he is quite happy at the hospital, working in the canteen, and does not look forward to leaving. He is a generous man who shares the $40 he receives each week from the government with fellow patients.
Kathy, like 17 million other Americans, suffers from depression. She came to Haverford because of a suicide attempt following the death of several close relatives. She is ambivalent about leaving the hospital, looking forward to it one day, apprehensive the next.
Sarah used to ride the horse show circuit. Her manic depression has led her to cycle in and out of hospitals. She still loves horses and would like to leave Haverford, but lacks confidence in herself. She and her sister recount how her manic episodes have caused problems in the past.
Joanne interviews Charles Curie of the Pennsylvania State Department of Public Welfare. He explains how alternatives to institutional care are less expensive and less likely to encourage dependency. People do better in community care, he says.
In fact, when a hospital in Philadelphia closed, it was tracked by economists from the University of Pennsylvania. They found public money to be better spent on community care--and no increase in homelessness from the closure.
Haverford's closing was in part spurred by a lawsuit that used the Americans With Disabilities Act to argue people with mental illnesses should be kept in the least restrictive setting possible. The courts agreed and set up a strict timetable for transition to community-based care.
Robbie Altenor is the wife of Aidan Altenor and an advocate for community-based care. Her job, she says, is not always easy. Zoning regulations and people's attitudes and fears can make setting-up smaller facilities difficult.
Where are Carlos, Sarah, and Kathy now, nine months after Haverford State shut its doors?
Sarah lives in her own apartment and works two part-time jobs. One is in a department store, where she was recently given a sales award. The other is at a barn where she can work with her beloved horses.
By most accounts, her life looks good. But there are problems. On her own Sarah cannot afford her medications, which run to as much as $400 a month, and regular visits to both psychiatrist and psychologist. So she gets heath insurance through public assistance (SSDI), but the aid means she cannot work as many hours as she would like. At the same time, she has become friends with her landlord but keeps her distance from most others. She is afraid people who know her will be turned off by the fact that she was in the hospital. Sometimes she misses the way things were "taken care of" at Haverford.
The staff at Haverford decided Carlos was not ready to be discharged. He moved on to Norristown State Hospital, another psychiatric facility. But after 20 years at Haverford, the transition has been difficult. Carlos was in good spirits when Joanne spoke to him last, but he has been involved in fights with other patients and even threw a chair at the nurses' station. Still, Aidan Altenor, who now runs Norristown State, is confident that one day Carlos will be well enough to live outside an institution. In fact, he blames Carlos' current difficulties in part on his two decades in institutions.
Kathy lives in a group home in Boothwyn, PA run by an organization called Impact. She likes it there very much--more than Haverford--and is currently in a work program, learning to use computers. Sometimes she misses the people from Haverford, but she likes the freer atmosphere of her new home.
Joe Rogers, Executive Director of the Mental Health Association of Southeastern Pennsylvania and Joe Bevilacqua, a mental health policy expert who's been commissioner of mental health in three states, comment on the need for community treatment as opposed to hospitalization in large state facilities.
Patient advocate Jo Halberstadter says she is excited by the trend toward community care. Giving people a higher degree of responsibility and independence, she says, pays off. They become more responsible and independent themselves.
Joanne Silberner ends the piece by observing that people with mental illnesses are now being returned to their communities--where they were before Dorothea Dix started her reforms. The difference is that now the government is involved. It's the follow-through to de-institutionalization is the most crucial part. Will other state governments commit to community care--with government supervision--the way that Pennsylvania has? What might happen if they don't? These questions remain to be answered.
For more information about mental illnesses, their treatment, and community support programs, you can contact any of the following groups:
National Mental Health Association
phone: 800-969-6642
National Alliance for the Mentally Ill
phone: 800-950-6264
Depression and Bipolar Support Alliance
phone: 800-826-3632
For more information on the closing of Haverford State Hospital you can contact the Mental Health Association of Southeastern Pennsylvania at 800-688-4226.
This program was funded by a grant from the Kaiser Media Fellowship Program.
This article was
written by Joanne Silberner
and published by The Infinite Mind
on Wednesday, June 21